Angelica Divinagracia of Van Nuys, Calif., tapes her foot every night before bed and again before teaching her thrice-weekly step classes. Richard Erde of Brooklyn had custom orthotic devices for his tennis shoes and sleeps on his stomach with his feet hanging over the end of the bed.
Both are trying to reduce the strain on a much-discussed tissue in the foot–the plantar fascia–that few Americans had even heard of before being bitten by the fitness bug. The painful problem that Divinagracia, Erde and many thousands of runners and others share is called plantar fasciitis.
Like tennis elbow and shin splints, plantar fasciitis is most often an overuse injury that afflicts those who use their feet extensively for running, walking, stepping or even prolonged standing. It is a classic repetitive-stress injury that if recognized and treated early, can be readily overcome. If it is ignored will, it only get worse until it becomes disabling.
The plantar fascia is a ligament, a tough, fibrous structure, on the bottom of the foot, connected at one end to the heel bone. It fans out along the plantar surface, or sole, of the foot to attach at its other end to the five metatarsal bones of the toes.
In the process, the plantar fascia helps maintain the arch and hold the foot rigid as you push off with each step. Ligaments stretch little, if at all, but they can tear and become inflamed. Repeated stress or pressure on the fascia where it attaches to the heel bone can cause microtears and painful inflammation in the arch near the heel.
If not corrected in time, the inflammation and tension on the fascia can tug on the membrane surrounding the heel bone. That stress, in turn, prompts the body to lay down additional bone to form a spur, which can add to the discomfort.
Plantar fasciitis can afflict anyone who participates in weight-bearing activities. The people who have a higher risk of getting the disorder are those who have either highly arched or flat feet; who are overweight; who have feet that turn in excessively, causing the arch to collapse with each step; or who have inflexible calf muscles and a tight Achilles tendon, which both place extra stress on the fascia.
The factors that may precipitate the problem include switching from working out on a resilient surface to one made of concrete or hardwood; wearing poorly cushioned or worn-out shoes or shoes not designed for the activity, and suddenly increasing training intensity.
This is one athletic injury that a layperson is likely to be able to diagnose. It feels worse after resting. Its classic symptom is pain in the forward part of the heel that is most severe in the morning, with the first steps taken after getting out of bed and after prolonged sitting, probably because of the tearing of scar tissue that had begun to form during the period of rest. The pain usually eases during activity and becomes worse again afterward.
Those with plantar fasciitis also are likely to feel intense pain when pressure is applied to the front of the heel bone, where the fascia attaches.
Sports medicine specialists say that self-treatment is likely to be helpful if the problem is intercepted in its early stages. The recommended measures start before getting out of bed.
Lightly stretch and warm your calf muscles by pointing your toes toward the ceiling and making circles with your feet. Never go barefoot or wear slippers or shoes without a raised heel. Replace worn-out exercise shoes and fit all your shoes with orthotics (over-the-counter ones will do if the problem is not advanced) that support the arch and elevate the heel, or use heel lifts in your shoes to take some of the pressure off the fascia. If it hurts too much to step on the injured part of your heel, cut a hole in the lift at that point.
The regular use of an over-the-counter anti-inflammatory pain medication, like ibuprofen or aspirin, is almost universally recommended, especially before performing an activity that stresses the fascia.
If you are a runner, avoid hills and speed work. If you are accustomed to doing one long workout, break it up into two shorter ones.
Tape your foot with an elastic bandage before going to bed to hold it at a right angle with your leg, which will keep the tissues in the back of the calf from shortening while you sleep. Or adopt Erde’s sleep position. Taping can also help support the arch during activity.
Ice the bottom of your foot after every activity that stresses the fascia. Some experts recommend massaging the area for 5 to 10 minutes at a time, or until the injured area is numb, with ice frozen inside a paper cup.
If such measures do not bring adequate relief, see a physician, preferably one who specializes in sports medicine, or a podiatrist. You may need the assistance of a physical therapist or custom-made orthotics for your shoes.
